Comparison of two transcatheter device strategies for occlusion of the patent ductus arteriosus.
OBJECTIVE
The present study evaluates two transcatheter closure strategies utilized at a single center and makes recommendations for device selection when occluding the patent ductus arteriosus.


BACKGROUND
A variety of devices are available for transcatheter closure of the patent ductus arteriosus (PDA) but no guidelines exist to guide operator device choice.


METHODS
A total of 132 patients underwent attempted transcatheter PDA closure utilizing one of two consecutive closure strategies between January 2000 and June 2005. Strategy A (n = 64; January 2000-May 2003) utilized Gianturco coils only. Strategy B (n = 68; June 2003-June 2005) utilized a single Gianturco coil for the PDA with a minimal diameter <or=1 mm (n = 28) or an Amplatzer Duct Occluder (ADO) if the PDA diameter exceeded 1 mm (n = 40). Success was defined as complete occlusion on a follow up echocardiogram.


RESULTS
58 of 64 (90.6%) patients treated utilizing strategy A had successful coil implantation. 68 of 68 (100%) patients treated utilizing strategy B had successful coil/device implantation. At follow up echocardiography, 32 of 44 (72.7%) strategy A patients had complete ductal closure, as compared with 57 of 58 (98.3%) strategy B patients (P < 0.0001). Stepwise logistic regression analysis identified closure strategy as the most powerful predictor of procedural success (OR = 85.9; CI 5.6-9.99).


CONCLUSIONS
A transcatheter PDA closure strategy consisting of a single Gianturco coil for PDA <or= 1 mm or an ADO for larger sized PDA (strategy B) achieves superior outcomes compared to the use of coils alone.
Gudausky
Todd M
TM
Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. tgudausky@chw.org
Hirsch
Russel
R
Khoury
Philip R
PR
Beekman
Robert H
RH
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011859:Radiography; D018570:Risk Assessment; D016896:Treatment Outcome; D014463:Ultrasonography